Organization
GRATIA PLENA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH BUCKLE PSY.D. (PRESIDENT)
(832) 532-0129
Entity
Organization
Contact information
Practice address
10707 CORPORATE DR, SUITE 135, STAFFORD, TX 77477-4095
(832) 532-0129
Mailing address
10707 CORPORATE DR, SUITE 135, STAFFORD, TX 77477-4095
(832) 532-0129
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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